Excellus BCBS Members Benefiting from Higher Portion of Premiums Spent on Medical Care

Health plan exceeds government minimums by quarter billion dollars

Excellus BlueCross BlueShield spent $255 million more on hospital and physician services, prescriptions and other medical benefits for its commercial members than federal and state standards required in 2011, under the provisions of the federal Patient Protection and Affordable Care Act, officials reported.

"We seek to provide competitive, affordable access to coverage in our markets that maximize benefits for our customers," said Christopher Booth, chief operating officer for the health plan and its CEO-elect for 2013. "By exceeding the standards, it means our members collectively got more in medical benefits throughout the year than the minimum amounts set by federal and state governments."

Federal standards, as they apply to New York State commercial insurance customers, set the minimum level of benefits to be 82 percent of premium revenues in the individual direct pay market along with small groups and 85 percent for large groups. Excellus BCBS reports that it spent 93.4 percent of premium revenues on medical benefits for its individual direct pay membership, 90.9 percent for small groups and 90.9 percent for large groups.

Converting the percentage differences to dollars means that the health plan exceeded the standards of medical benefit payments on behalf of its membership by $255 million.

Federal officials have estimated that hundreds of millions of dollars in refunds will be owed by other health plans throughout the country, even in states where the minimum standards are lower than those in New York.

While exceeding the standards, Excellus BCBS is required to send out notices to members reporting that no refunds will be made. Those notifications will take place later this year.